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With my recovery nearly complete, my posts here will be less frequent than they once were. I’ll still be posting about billing and insurance when there’s news on that front. I’ll also post updates on any new developments with my injuries if and when things arise. Eventually, I’ll get around to posting about some of the things I’ve learned from my accident and its aftermath (including a guide for those who are recovering from similar injuries) and how my experiences have influenced my worldview.

In the mean time, there are a few things that I probably should have mentioned a while ago. I’ll post three here. I may include more in subsequent posts.

Some time after I returned from my oral surgery, I found an x-ray of my mouth among the things that I had carried home from the surgeon’s office. I have never had any recollection of the taking of the x-ray, but it was apparently done after I had my mouth wired, as the wires are visible. Here it is. Note that the left side of my mouth (with the fracture) appears on the right side of the image.

It seems that I’ve neglected to explain that the part of my jaw that I broke, the condyle (or maybe it was the neck of the condyloid process, just below the condyle) is located near the joint with the upper jaw, rather than near the teeth. I suspect that this made the recovery easier than it otherwise might have been because the pictures of jaws broken between the teeth look far more gruesome than anything I saw on my own face.

A few days after the oral surgeon wired my mouth shut, my mother mentioned to me that she had read that people who have their jaws wired shut often have to carry wire cutters for emergency use. I had no recollection of the oral surgeon saying anything to me about wire cutters, but I could not rule out the possibility that he had said something but I could not remember because I was still feeling the anesthesia. Furthermore, some research showed that my mother’s claim was correct. Moreover, I discovered a few days before my wireless upgrade that the instructions I received from the hospital said,

If your jaw was wired shut, it is important that you be able to open the wires in any emergency that makes it difficult to breathe, such as vomiting, extreme coughing or choking. Therefore, you must carry a pair of small wire-cutters with you at all times. Be sure you know which wires to cut in case this is necessary. If not, ask your doctor.

To be clear, this came from the hospital, and I had my jaw wired a few days later by an oral surgeon at a different practice. But I never carried a wire cutter. I’m still alive today. Go figure.

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I just got back from my routine six-month cleaning at the dentist’s office. I only saw a hygienist; the dentist didn’t look at my mouth. To my relief, she didn’t find any cavities. She told me that one of my back teeth has a deep groove in it that will need to be brushed extra carefully, but she emphasized that this was the anatomy of the tooth rather than a cavity.

When my mouth was wired shut, I was unable to brush most surfaces of my teeth, so I find it quite remarkable that I don’t have any cavities. A large part of this, as the hygienist pointed out, is that I’m lucky to have hard enamel. What I don’t owe to luck, I owe to my WaterPik, which proved to be an absolutely indispensable tool for cleaning my teeth and the wires around them.

I also learned that the dentist’s office has already billed my second insurance for the rest of the charges on my account. I should be receiving a bill for whatever they don’t pay in a few weeks. The statement of benefits from the insurance company, however, will probably go to my parents’ address.

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For the first few weeks after my accident, and then again in the first several days after my chipped teeth were repaired, I’d often wonder what my teeth had looked like before the accident and lament that I’d never know. On this point, however, I was wrong.

When I got my braces off just short of eight years ago, my orthodontist made models of my teeth. These were to be used to shape the clear plastic retainers that I would have to wear regularly from then on. For most of the past eight years, the models have sat collecting dust in my old room in my parents’ house.

For me, the most striking thing about the models (which unfortunately my photograph doesn’t adequately show) is that they show that my right front tooth was actually slightly bigger than the left front tooth before the former was chipped in the accident. In the repaired version, the edge of my right front tooth (number 8 for the dental notation enthusiasts out there) slants so that the tooth approximately matches both of its neighbors in length where it meets them. In particular, the right front tooth is considerably smaller than its neighbor to the left, and it also looks weird.

The models also confirm that my bottom front teeth have moved a little bit. The two in the center now stick out slightly further than the ones to the left and right. This is something that I’ve suspected since my jaw was wired shut, when I detected a change in the way things felt to my tongue. I’m hoping that the movement is due to pressure applied by the wires in my mouth and that the movement is slight enough that my retainers will be able to nudge them back into place after I get the arch bars out.

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Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

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I don’t think I’ve ever been as excited to go to a dentist as I was today. As I walked there, I started to feel nervous, though. What if I were to open my mouth for the first time in three weeks and hear my jaw break again? I tried my best to forget about this thought.

When I got to the oral surgeon’s office, the receptionist recognized me and was ready with a waiver for me to sign for the procedure. I signed the waiver, which warned me about a number of things, many of which should have been irrelevant to this procedure (i.e. dry socket). A woman whom I hadn’t seen in the office before took me back to a room with a dentist’s chair and asked if I had any questions. I asked what my diet should be like with the wire off, and she said I should stick to soft foods, which didn’t surprise me. She had me sit down in the chair and asked if I wanted nitrous oxide. I asked if I needed it, and she said the surgeon would need to numb me for the procedure.

Just then, the surgeon walked in through the door, and said, “No, I don’t. She’s lying.” He explained to her that he was only taking off the wires fastening my jaw shut, and not the “arch bars”, which I gathered were the braces on my upper and lower jaws. He assured me that the procedure would be painless, and he wouldn’t even have to touch my gums. He went on to add, “You know what is going to hurt? When you try to open your mouth.” He explained that this was because I hadn’t used the muscles in my jaws for three weeks, and he compared it to the pain of getting up off the couch after sitting there without moving for three weeks. I didn’t tell him this, but I felt that the analogy was a failure because I had never sat on the couch for that long. He did, at least, tell me that it would get better relatively quickly, and I wouldn’t need to do any jaw exercises.

In any case, he looked into my mouth, and told me he was impressed by how clean it was. “Hygiene is important,” he said, “It plays a big role in how you feel about yourself.” My self esteem has never been tied to my oral hygiene, but perhaps that’s because I don’t have a degree in dentistry. He then cut off the wires, and told me, “You’re a free man.” I started to get up out of the chair, but then he said, “You can open your mouth,” and I realized what he had meant. So I opened my mouth nice and wide, and somehow it didn’t hurt. Then I opened it a little bit wider and it hurt quite a bit, so I closed it again. I opened my mouth again, this time stopping before I felt any pain, and then slowly closed my mouth again. On the left side, my teeth felt soft against each other, but I hoped that this was just because I was unaccustomed to my top and bottom teeth moving relative to each other.

The oral surgeon explained that my bones will be considered to have healed in three weeks, and for the intervening time, I’ll have rubber bands in my mouth. As for eating, I’m not allowed to chew; the rule is that if I can slurp it, I can eat it. He warned me against Wonderbread (in which I have no interest, even not knowing whether it’s vegan) with peanut butter and jelly because that requires chewing. He listed a number of foods I can eat, including refried beans and rice, pasta, and mashed potatoes. I’m skeptical of his claim that pasta and rice can be eaten without chewing (unless blended), but I should be able to find enough to eat without his suggestions. After three weeks, I’ll be able eat some foods that require chewing, but apples will still be too hard. I’m also free to have my dentist repair my chipped teeth now.

The oral surgeon had his assistant give me toothpaste and a children’s toothbrush and instructed me to brush my teeth and my tongue while he went and did something else. The toothpaste, of course, was the non-vegan Crest, but I used it because I didn’t have my own toothpaste with me. I brushed the outsides of my teeth as I have been doing for the last few weeks, but when it came time to brush my tongue and the insides and tops of my teeth, I realized that I wasn’t able to open my mouth enough for the toothbrush (even being a children’s size) to fit through. I ended up having to settle for cleaning those parts of my mouth by rinsing. I might be a free man, but only in the sense that somebody who gets out of prison and put on house arrest is free. I’m more free than in the immediate past, but I’ve had better.

After I had cleaned my mouth, the surgeon showed me how to hook rubber bands onto the braces, which he explained were to make sure my teeth are “in the right ZIP code.” I can take the rubber bands out, but only when eating or brushing my teeth.

He told me I should come back to check in with him in two weeks. He isn’t planning on doing anything except taking a look at my mouth then, but he said that he’d have to wire it shut again if my teeth were in the wrong place. I was relieved to hear that he’s only had to do that once, but it didn’t occur to me at the time to ask how many patients he’s treated with this kind of injury.

After a quick stop at the front desk to schedule my appointment, I was on my way back to my office.

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I stopped by a university gym early this afternoon to weigh myself and see whether I had succeeded in my challenge. My weight was 152 pounds after emptying my pockets. This represents a loss of three pounds from my baseline reading. This is within the normal range of fluctuations of human weight, and given that the readings were taken on different scales, I’ll declare myself more or less successful.

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It took me until my last seventeen hours wired, but I finally got some grains into my diet. I poured some pasta sauce into my blender and then added a bit of whole wheat pasta. I don’t remember the exact amounts, but I think that it probably about a cup of cooked pasta (rigatoni) and perhaps a little bit less sauce by volume. I turned on the blender for several minutes before adding a little bit of water to thin it out. I tested to see that it would pass through a straw and into my mouth before adding a little bit of nutritional yeast and blending for a few more seconds.

The taste isn’t great. The tomato flavor is very much stronger than I would like because it’s more sauce than I’d usually use for this amount of pasta, but I’m glad to have solved the problem of how to imbibe some whole grains, even if the practical significance is minimal at this point.

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About

I'm Adam Merberg. I wrote this blog after I had a bicycle accident and thought it might be useful to document the various injuries (a broken jaw among them) that resulted. If you have questions about anything you read here, feel free to email me. These days, I don't update this blog often because I consider myself to be fully recovered, but I do try to reply to comments and emails.

Please note that this blog is not a substitute for professional medical advice or treatment. If you have reason to believe that you have broken your jaw, you should see a doctor.